Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India
Identifieur interne : 000046 ( Pmc/Checkpoint ); précédent : 000045; suivant : 000047Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India
Auteurs : Usha Thamattoor [Inde] ; Tinku Thomas [Inde] ; Pradeep Banandur [Inde] ; Rajaram S [Inde] ; Thierry Duchesne [Canada] ; Belkacem Abdous [Canada] ; Reynold Washington [Inde] ; Ramesh B M [Inde] ; Stephen Moses [Canada] ; Michel Alary [Inde, Canada]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Abstract
Heterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively.
Data on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity.
The average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age≥25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04).
Illiteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.
Url:
DOI: 10.1371/journal.pone.0131629
PubMed: 26147208
PubMed Central: 4492681
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</nlm:aff>
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<author><name sortKey="Alary, Michel" sort="Alary, Michel" uniqKey="Alary M" first="Michel" last="Alary">Michel Alary</name>
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</nlm:aff>
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</nlm:aff>
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<wicri:regionArea>Centre de recherche du CHU de Québec, Québec</wicri:regionArea>
<wicri:noRegion>Québec</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>Département de médecine sociale et préventive, Université Laval, Québec, Canada</addr-line>
</nlm:aff>
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<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title>
<p>Heterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>Data on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>The average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age≥25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04).</p>
</sec>
<sec id="sec004"><title>Conclusion</title>
<p>Illiteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct></biblStruct>
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<biblStruct><analytic><author><name sortKey="Banandur, P" uniqKey="Banandur P">P Banandur</name>
</author>
<author><name sortKey="Rajaram, Sp" uniqKey="Rajaram S">SP Rajaram</name>
</author>
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</author>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group><journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, CA USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26147208</article-id>
<article-id pub-id-type="pmc">4492681</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0131629</article-id>
<article-id pub-id-type="publisher-id">PONE-D-14-02225</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India</article-title>
<alt-title alt-title-type="running-head">Multilevel Analysis of Predictors of HIV Prevalence ANC Women India</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Thamattoor</surname>
<given-names>Usha</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref rid="cor001" ref-type="corresp">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Thomas</surname>
<given-names>Tinku</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Banandur</surname>
<given-names>Pradeep</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>S</surname>
<given-names>Rajaram</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Duchesne</surname>
<given-names>Thierry</given-names>
</name>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Abdous</surname>
<given-names>Belkacem</given-names>
</name>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Washington</surname>
<given-names>Reynold</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>B M</surname>
<given-names>Ramesh</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Moses</surname>
<given-names>Stephen</given-names>
</name>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Alary</surname>
<given-names>Michel</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>St John’s Research Institute, Bangalore, 560034, India</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>CHARME II Project, Bangalore, 560044, India</addr-line>
</aff>
<aff id="aff003"><label>3</label>
<addr-line>Department of Epidemiology, National Institute of Medical Sciences (NIMHANS), Bangalore, 560029, India</addr-line>
</aff>
<aff id="aff004"><label>4</label>
<addr-line>Karnataka Health Promotion Trust, Bangalore, 560044, India</addr-line>
</aff>
<aff id="aff005"><label>5</label>
<addr-line>Centre de recherche du CHU de Québec, Québec, Canada</addr-line>
</aff>
<aff id="aff006"><label>6</label>
<addr-line>Département de mathématiques et de statistique, Université Laval, Québec, Canada</addr-line>
</aff>
<aff id="aff007"><label>7</label>
<addr-line>Département de médecine sociale et préventive, Université Laval, Québec, Canada</addr-line>
</aff>
<aff id="aff008"><label>8</label>
<addr-line>Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Luo</surname>
<given-names>Xi</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>Brown University, UNITED STATES</addr-line>
</aff>
<author-notes><fn fn-type="conflict" id="coi001"><p><bold>Competing Interests: </bold>
The authors have declared that no competing interests exist.</p>
</fn>
<fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: MA RW RBM SM. Analyzed the data: UT TT PB RS TD BA MA. Wrote the paper: UT TT PB RS TD BA MA RW RBM SM.</p>
</fn>
<corresp id="cor001">* E-mail: <email>ushakm@rediffmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>6</day>
<month>7</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="collection"><year>2015</year>
</pub-date>
<volume>10</volume>
<issue>7</issue>
<elocation-id>e0131629</elocation-id>
<history><date date-type="received"><day>18</day>
<month>1</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>4</day>
<month>6</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-year>2015</copyright-year>
<copyright-holder>Thamattoor et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:type="simple" xlink:href="pone.0131629.pdf"></self-uri>
<abstract><sec id="sec001"><title>Background</title>
<p>Heterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>Data on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>The average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age≥25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04).</p>
</sec>
<sec id="sec004"><title>Conclusion</title>
<p>Illiteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.</p>
</sec>
</abstract>
<funding-group><funding-statement>This research was funded by the Bill & Melinda Gates Foundation. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation.</funding-statement>
</funding-group>
<counts><fig-count count="1"></fig-count>
<table-count count="4"></table-count>
<page-count count="11"></page-count>
</counts>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Canada</li>
<li>Inde</li>
</country>
<region><li>Manitoba</li>
</region>
<settlement><li>Winnipeg</li>
</settlement>
<orgName><li>Université du Manitoba</li>
</orgName>
</list>
<tree><country name="Inde"><noRegion><name sortKey="Thamattoor, Usha" sort="Thamattoor, Usha" uniqKey="Thamattoor U" first="Usha" last="Thamattoor">Usha Thamattoor</name>
</noRegion>
<name sortKey="Alary, Michel" sort="Alary, Michel" uniqKey="Alary M" first="Michel" last="Alary">Michel Alary</name>
<name sortKey="B M, Ramesh" sort="B M, Ramesh" uniqKey="B M R" first="Ramesh" last="B M">Ramesh B M</name>
<name sortKey="B M, Ramesh" sort="B M, Ramesh" uniqKey="B M R" first="Ramesh" last="B M">Ramesh B M</name>
<name sortKey="Banandur, Pradeep" sort="Banandur, Pradeep" uniqKey="Banandur P" first="Pradeep" last="Banandur">Pradeep Banandur</name>
<name sortKey="Banandur, Pradeep" sort="Banandur, Pradeep" uniqKey="Banandur P" first="Pradeep" last="Banandur">Pradeep Banandur</name>
<name sortKey="S, Rajaram" sort="S, Rajaram" uniqKey="S R" first="Rajaram" last="S">Rajaram S</name>
<name sortKey="S, Rajaram" sort="S, Rajaram" uniqKey="S R" first="Rajaram" last="S">Rajaram S</name>
<name sortKey="Thamattoor, Usha" sort="Thamattoor, Usha" uniqKey="Thamattoor U" first="Usha" last="Thamattoor">Usha Thamattoor</name>
<name sortKey="Thomas, Tinku" sort="Thomas, Tinku" uniqKey="Thomas T" first="Tinku" last="Thomas">Tinku Thomas</name>
<name sortKey="Thomas, Tinku" sort="Thomas, Tinku" uniqKey="Thomas T" first="Tinku" last="Thomas">Tinku Thomas</name>
<name sortKey="Washington, Reynold" sort="Washington, Reynold" uniqKey="Washington R" first="Reynold" last="Washington">Reynold Washington</name>
<name sortKey="Washington, Reynold" sort="Washington, Reynold" uniqKey="Washington R" first="Reynold" last="Washington">Reynold Washington</name>
</country>
<country name="Canada"><noRegion><name sortKey="Duchesne, Thierry" sort="Duchesne, Thierry" uniqKey="Duchesne T" first="Thierry" last="Duchesne">Thierry Duchesne</name>
</noRegion>
<name sortKey="Abdous, Belkacem" sort="Abdous, Belkacem" uniqKey="Abdous B" first="Belkacem" last="Abdous">Belkacem Abdous</name>
<name sortKey="Abdous, Belkacem" sort="Abdous, Belkacem" uniqKey="Abdous B" first="Belkacem" last="Abdous">Belkacem Abdous</name>
<name sortKey="Alary, Michel" sort="Alary, Michel" uniqKey="Alary M" first="Michel" last="Alary">Michel Alary</name>
<name sortKey="Alary, Michel" sort="Alary, Michel" uniqKey="Alary M" first="Michel" last="Alary">Michel Alary</name>
<name sortKey="Duchesne, Thierry" sort="Duchesne, Thierry" uniqKey="Duchesne T" first="Thierry" last="Duchesne">Thierry Duchesne</name>
<name sortKey="Moses, Stephen" sort="Moses, Stephen" uniqKey="Moses S" first="Stephen" last="Moses">Stephen Moses</name>
</country>
</tree>
</affiliations>
</record>
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